=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841424363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KING HILL MEDICAL SUPPLY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2009
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2930 W IMPERIAL HWY UNIT 200 D
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90303-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-242-9700
-----------------------------------------------------
Fax | 323-242-9800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2930 W IMPERIAL HWY UNIT 200 D
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90303-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-242-9700
-----------------------------------------------------
Fax | 323-242-9800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EMEKA UGWUEZE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-242-9700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 51778
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------